Library

Resource

Home testing

What Is the Role of HIV Testing at Home?

Is home HIV testing feasible?

Home-access testing for HIV met with virtually unanimous opposition when it was first proposed.1 Today, the Centers for Disease Control (CDC), leading clinicians, gay activists and AIDS advocates have all endorsed home access testing.2 The barriers to home access testing have not been technical, as feasibility studies have demonstrated.3 Home testing has been possible for more than a decade. Actually, “home testing” is a little misleading: customers don’t actually get on-the-spot results, the way they do with home test kits for glucose, cholesterol, blood pressure or pregnancy. The tests are really at-home “collection kits” to be purchased over the counter or through the mail. A test kit purchaser pricks his/her finger, puts a drop of blood on a piece of blotter paper, sends it off in the mail, then phones for results and counseling after a specified time. In the spring of 1996, the Food and Drug Administration (FDA) approved the first HIV home collection test kit, Confide. The kit, sold by a subsidiary of Johnson & Johnson, was later withdrawn from the market. The FDA later licensed Home Access HIV-1 Test System, manufactured by Home Access Health Corporation of Chicago. This remains the only home collection kit approved for sale by the FDA, although a dozen other unapproved home test kits have been advertised for sale in newspapers and via the Internet. The FDA cautions against the use of these unapproved test kits, which have not been fully evaluated and “do not have a documented history of delivering dependable results.”4

How is it different?

It’s an easy way for people to find out if they’re HIV infected. Traditionally, getting tested for HIV has meant a trip to a doctor or clinic, getting blood drawn, then returning for results and counseling. The new home testing kits save two trips to the doctor or clinic. It also makes testing accessible for people who live in rural areas, or inner cities where clinics are scarce, too busy, or a long bus ride away. Home testing also affords privacy. Some people are afraid to visit a clinic or doctor’s office because they fear they will be recognized by neighbors, friends, or family. In a number of studies, at-risk individuals have expressed preference for anonymous systems of HIV testing.5 Home testing has the potential for complete anonymity. Offering another testing option is a step toward solving the national problem of inadequate HIV testing. An alarmingly high proportion of those at risk has not been tested for HIV.6 Getting HIV test results becomes more and more important as means of bolstering the immune system and staving off opportunistic infections improve. Pregnant women are being encouraged to take voluntary HIV tests in light of studies showing that treating HIV-infected pregnant women with zidovudine (AZT) can reduce the rate of maternal/fetal transmission of HIV by two-thirds.7

Are the results reliable? private?

Millions of HIV antibody tests have been conducted using dried blood specimens.8 Such testing is highly accurate when laboratory protocols for confirmatory testing and quality assurance mechanisms are followed. False positive results do occur in HIV testing, but at a very low rate. Some test kit blotters mailed to the lab may not have enough blood to test. In such situations, telephone counselors have been trained to advise customers when results are unclear or need further confirmation. Each test comes with a unique identification number, which patients return to the lab with their blood samples. The lab never knows a name. When calling for results, patients identify themselves by this number alone.

Who will get tested at home?

Home access HIV testing may provide reassurance to the “worried well”-people for whom the risk of HIV infection may be quite remote, but are nevertheless seeking reassurance. If such individuals no longer rely on public sources of testing, resources may be freed up for more targeted interventions with those at highest risk.9 Sales of home test kits have not been quite as robust as might have been expected from surveys in which people expressed their attitudes and intentions regarding home testing. In its first year, Home Access Health’s sold 152,044 test kits; 148,039 people called to find out their results. The overall HIV seropositive rate was 0.9%.10 Beyond the denial and psychological barriers to seeking testing, many may find the $30-40 retail cost for home test kits prohibitive. Home test kit companies are working with a variety of public health and community agencies, selling kits at wholesale prices so that home access testing can become part of various prevention outreach strategies.

What are the concerns?

One concern is the adequacy of counseling. At a doctor’s office or clinic, test results are usually delivered in person. If a patient feels overwhelmed, or even suicidal, an expert is there to help. Companies selling home test kits make counselors available, but they will be miles away on the other end of a telephone. As one critic of home testing put it, “a 1-800 number can’t hug you when you’re crying."11 Yet for some people, the remoteness and anonymity afforded by telephone counseling makes it easier to reveal painful feelings or embarrassing information. There is a long tradition with telephone counseling in crisis intervention and suicide prevention. Telephone counseling must be compared to the actual experiences of current HIV testing. For many, counseling is already inadequate or missing altogether. According to data from the National Health Interview Survey (NHIS), a third of those who were tested for HIV antibodies got their results by mail (16%) or telephone (17%).12 About 2.5 million tests are performed annually at publicly funded test sites. In 1995, 25% of people who tested positive and 33% who tested negative failed to return for their results.13 In contrast, 97.4% of buyers of the home test kit called for test results.10 Another concern is potential abuse of home test kits. Some fear that employers, family members or health providers could send someone’s blood sample to be tested without the person’s knowledge. Laws already exist against testing without consent and discrimination on the basis of HIV status. These statutes need to be enforced; new legal protections may be needed once there is more experience with home test kits.

What are the limitations?

A positive HIV test result does not guarantee access to needed care. As the National Commission on AIDS wrote, “for many impoverished individuals gaining entry into a health care and social service system by means of a ticket stamped `HIV positive’ is still a cruel hoax.”  Nevertheless, this is no reason to discourage people from seeking testing. “The lack of good medical and social services for people with HIV infection is an argument for increasing those services, not denying people access to personal medical information.”15 HIV testing is not an end in itself. A comprehensive HIV prevention strategy uses multiple elements to protect as many people at risk of HIV infection as possible. The real challenge is to ensure that wherever people are tested they have access to follow-up counseling and care. If they are HIV positive they should receive care to stay healthy, and if they are HIV negative they should receive support to stay negative.

Says who?

  1. Anon. Banned at home: an FDA ruling on AIDS test. Time. 1989; April 18:26.
  2. Leary WE. Government panel hears call for expanded AIDS testing. New York Times. 1994;June 23:A18.
  3. Frank AP, Wandell MG, Headings MD, Conant MA, Woody G, Michel C. Anonymous HIV testing using home collection and telemedicine: a multicenter evaluation. Archives of Internal Medicine. 1997;157:309-314.
  4. Center for Biologics Evaluation and Research, Food and Drug Administration (FDA). Testing yourself for HIV-1, the virus that causes AIDS–Home test system is available. 1997;July 25. https://www.fda.gov/vaccines-blood-biologics/hiv-home-test-kits/testing…;
  5. Hirano D, Gellert GA, Fleming K, et al. Anonymous HIV testing: the impact of availability on demand in Arizona. American Journal of Public Health. 1994;84:2008-2010.
  6. Sweeney PA, Fleming PL, Karon JM, Ward JW. A minimum estimate of the number of living HIV infected persons confidentially tested in the United States. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) 1997;Sept.-Oct., Toronto, Canada.
  7. Conner EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New England Journal of Medicine. 1994;331:1173-1180.
  8. Gwinn M, Redus MA, Granade TC. HIV-1 serologic test results for one million newborn dried-blood specimens: assay performance and implication for screening. Journal of Acquired Immune Deficiency Syndrome. 1992;5:505-12.
  9. Valdiserri RO, Weber JT, Frey R, Trends in HIV seropositivity in publicly finded HIV counseling and testing programs: implications for prevention policy. American Journal of Preventive Medicine. 1998;14:31-42.
  10. Home Access Health. http://www.homeaccess.com.
  11. Ocamb K. Home HIV testing is near. POZ. 1994;June-July:48-52. (quoting Dennis Ouellet, LA Free Clinic).
  12. Schoenborn CA, Marsh Sl, Hardy AM. AIDS knowledge and attitudes for 1992. Data from the National Health Interview Survey. Advance Data. 1994;243:1-15.
  13. Centers for Disease Control. Update: HIV counseling and testing using rapid tests–United States. Morbidity and Mortality Weekly Report. 1998;47: 211-5.
  14. National Commission on AIDS. Report of the Working Group on Social and Human Issues. Washington, DC: National Commission on AIDS, 1991.
  15. Bayer R, Stryker J, Smith MD. Testing for HIV infection at home. New England Journal of Medicine. 1995;332: 1296-1299.

Prepared by Jeff Stryker* *CAPS Updated August 1998. Fact Sheet #11Er

Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Francisco should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © August 1998, University of California.

Resource

Adolescents

What Are Adolescents’ HIV Prevention Needs?

Can adolescents get HIV?

Unfortunately, yes. HIV infection is increasing most rapidly among young people. Half of all new infections in the US occur in people younger than 25. From 1994 to 1997, 44% of all HIV infections among young people aged 13-24 occurred among females, and 63% among African-Americans. While the number of new AIDS cases is declining among all age groups, there has not been a comparable decline in the number of new HIV infections among young people.1 Unprotected sexual intercourse puts young people at risk not only for HIV, but for other sexually transmitted diseases (STDs) and unintended pregnancy. Currently, adolescents are experiencing skyrocketing rates of STDs. Every year three million teens, or almost a quarter of all sexually experienced teens, will contract an STD. Chlamydia and gonorrhea are more common among teens than among older adults.2 Some sexually-active young African-American and Latina women are at especially high risk for HIV infection, especially those from poorer neighborhoods. A study of disadvantaged out-of-school youth in the US Job Corps found that young African-American women had the highest rate of HIV infection, and that women 16-18 years old had 50% higher rates of infection than young men.3 Another study of African-American and Latina adolescent females found that young women with older boyfriends (3 years older or more) are at higher risk for HIV.4

What puts adolescents at risk?

Adolescence is a developmental period marked by discovery and experimentation that comes with a myriad of physical and emotional changes. Sexual behavior and/or drug use are often a part of this exploration. During this time of growth and change, young people get mixed messages. Teens are urged to remain abstinent while surrounded by images on television, movies and magazines of glamorous people having sex, smoking and drinking. Double standards exist for girls-who are expected to remain virgins-and boys-who are pressured to prove their manhood through sexual activity and aggressiveness. And in the name of culture, religion or morality, young people are often denied access to information about their bodies and health risks that can help keep them safe.5 A recent national survey of teens in school showed that from 1991 to 1997, the prevalence of sexually activity decreased 15% for male students, 13% for White students and 11% for African-American students. However, sexual experience among female students and Latino students did not decrease. Condom use increased 23% among sexually active students. However, only about half of sexually active students (57%) used condoms during their last sexual intercourse.6 Not all adolescents are equally at risk for HIV infection. Teens are not a homogenous group, and various subgroups of teens participate in higher rates of unprotected sexual activity and substance use, making them especially vulnerable to HIV and other STDs. These include teens who are gay/exploring same-sex relationships, drug users, juvenile offenders, school dropouts, runaways, homeless or migrant youth. These youth are often hard to reach for prevention and education efforts since they may not attend school on a regular basis, and have limited access to health care and service-delivery systems.7

Can education help?

Yes. Schools are an important venue for educating teenagers on many kinds of health risks, including HIV, STD and unintended pregnancy. Across the US and around the world, studies have shown that sexuality education for children and young people does not encourage increased sexual activity and does help young people remain abstinent longer. Effective educational programs have focused curricula, have clear messages about risks of unprotected sex and how to avoid risks, teach and practice communication skills, address social and media influences, and encourage openness in discussing sexuality.8 In addition, HIV prevention programs that are carefully targeted to adolescents can be highly cost effective.9

Are schools the only answer?

No. Young people need to get prevention messages in lots of different ways and in lots of different settings. Schools alone can’t do the job. In the US, many schools are being hampered by laws and funding that prohibit comprehensive sexuality education. The federal government earmarked $50 million per year for school-based abstinence-only programs which emphasize values, character building and refusal skills, but do not discuss contraception or safer sex.10 Although abstinence programs are effective at delaying the onset of sexual activity, they typically do not decrease rates of sexual risk activity among adolescents the way that safer sex interventions do.11 Youth who are not in school have higher frequencies of behaviors that put them at risk for HIV/STDs, and are less accessible by prevention efforts. A national survey of youth aged 12-19 found that 9% were out-of-school. Out-of-school youth were significantly more likely than in-school youth to have had sexual intercourse, had four or more sex partners, and had used alcohol, marijuana and cocaine.12 More intensive STD/HIV and substance abuse prevention programs should be aimed at out-of-school youth or youth at risk for dropping out of school. Programs targeting hard-to-reach adolescents at high risk for HIV are necessary in many different venues outside of schools. Programs based in venues such as residential child care facilities, alternative schools and youth detention centers are needed. Peer educators can use an empowerment-oriented approach targeted to youth aged 12-17 to teach about preventing HIV and STDs, and to mobilize and link resources for young people through social and community networks.13 Families play an important role in helping teenagers avoid risk behaviors. Frank discussions between parents and adolescent children about condoms can lead teens to adopt behaviors that will prevent them from getting HIV and other STDs. Research has shown that when mothers talked about and answered questions about condom use with their adolescents prior to sexual debut, the adolescents reported greater condom use at first intercourse and most recent intercourse, as well as greater lifetime condom use.14 The WEHO Lounge in Los Angeles, CA, is a coffee house and HIV testing and information center located between two of the busiest gay discos in town. It offers free confidential oral HIV testing, weekly community forums, peer counseling, drug adherence support groups, free condom distribution and a comprehensive youth and HIV resource library. The Lounge also sells coffee drinks. By placing this resource in the community and adapting it to the needs and habits of young gay men, the program has been highly successful with clients.15 Project VIDA in Chicago, IL, a community-based service organization, provides HIV prevention for high-risk urban Latina females, ages 12-24. Project VIDA incorporates empowerment and self-care themes into peer-facilitated street/community outreach and group interventions. They act on the belief that it is impossible to separate HIV risks from other cultural, environmental, interpersonal, and intrapsychic stressors that Latina youths face; and that coping skills can help manage the perplexities of these challenges.16

What needs to be done?

HIV prevention programs for adolescents must consider the developmental needs and abilities of this age group. Programs should focus on contextual factors that lead young people to engage in higher rates of sexual activity and lower rates of condom use, such as low self-esteem, depression, substance use, gang activity, stress of living in turbulent urban environments, or boredom/restlessness related to unemployment. Any program for adolescents should be interesting, fun and interactive, and involve youth in the planning and implementation. This is especially true for out-of-the-mainstream youth and youth from diverse cultures. Programs for hard-to-reach youth who are most at risk for HIV infection should be implemented in venues outside of schools, such as runaway/homeless youth shelters, shopping malls, detention facilities and recreation/community centers. Adolescents not only need correct information and practice in self-protective skills, but also easy access to condoms in order to keep themselves risk-free.

Says who?

1. Centers for Disease Control and Prevention. Young people at risk-epidemic shifts further toward young women and minorities. Fact sheet prepared by the CDC. July 1998. 2. Eng TR, Butler WT, eds. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1996. 3. Valleroy LA, MacKellar DA, Karon JM, et al. HIV infection in disadvantaged out-of-school youth: prevalence for US Job Corps entrants, 1990 through 1996 . Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1998;19:67-73. 4. Miller KS, Clark LF, Moore JS. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents . Family Planning Perspectives. 1997;29:212-214. 5. UNAIDS. Force for Change: World AIDS Campaign with Young People . Report prepared by UNAIDS, The Joint United Nations Programme on HIV/AIDS for World AIDS Day 1998. 6. Centers for Disease Control and Prevention. Trends in sexual risk behaviors among high school students-United States, 1991-1997 . Morbidity and Mortality Weekly Report. 1998;47:749-752. 7. Rotheram-Borus MJ, Mahler KA, Rosario M. AIDS prevention with adolescents . AIDS Education and Prevention. 1995;7:320-336. 8. UNAIDS. Impact of HIV and sexual health education on the sexual behavior of young people: a review update . Report prepared by UNAIDS, The Joint United Nations Programme on HIV/AIDS for World AIDS Day 1997. 9. Pinkerton SD, Cecil H, Holtgrave D.R. HIV/STD prevention interventions for adolescents: cost-effectiveness considerations . Journal of HIV/AIDS Prevention and Education for Adolescents and Children. 1998;2:5-31. 10. Associated Press. Sex education that teaches abstinence wins support. New York Times. July 23,1997:A19. 11. Jemmott JB, Jemmott LS, Fong GT. Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents: a randomized controlled trial . Journal of the American Medical Association. 1998;279:1529-1536. 12. Centers for Disease Control and Prevention. Health risk behaviors among adolescents who do and do not attend school-United States, 1992 . Morbidity and Mortality Weekly Report. 1994;43:129-132. 13. Zibalese-Crawford M. A creative approach to HIV/AIDS programs for adolescents . Social Work in Health Care. 1997;25:73-88. 14. Miller KS, Levin ML, Whitaker DJ, et al. Patterns of condom use among adolescents: the impact of mother-adolescent communication . American Journal of Public Health. 1998;88:1542-1544. 15. Weinstein M, Farthing C, Portillo T, et al. Taking it to the streets: HIV testing, treatment information and outreach in a Los Angeles neighborhood coffee house. Presented at the 12th World AIDS Conference, Geneva, Switzerland; 1998. Abstract #43125. 16. Harper GW, Contreras R, Vess L, et al. Improving community-based HIV prevention for young Latina women. Presented at the Biennial Meeting of the Society for Community Research and Action, New Haven, CT; June,1999.

Prepared by Gary W. Harper, PhD MPH* and Pamela DeCarlo** *Department of Psychology, DePaul University, **CAPS

April 1999. Fact Sheet #9ER

Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Franciso should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © April 1999, University of California

Resource

Healthy Oakland Teens (HOT)

NOTE: The HOT Project ended in 1995. For a list of more recent, effective school-based sexuality/HIV education programs, please see:

 

The Center for AIDS Prevention Studies began providing innovative HIV prevention education in Oakland, CA in 1989. The Healthy Oakland Teens Project (HOT) began in the fall of 1992 at an urban, ethnically diverse junior high school. The project's goal was to reduce adolescents' risk for HIV infection by using peer role models to advocate for responsible decision making, healthy values and norms, and improved communication skills. The HOT program was very successful.

After extensive training, the ninth grade peer helpers delivered weekly interactive sessions in seventh-grade science classes, focusing on values, decision-making, communication, and prevention skills. The program trained 30 ninth grade peer helpers who in turn taught 300 seventh graders each year.

Each semester the peers designed their own group logo which was printed on T-shirts worn enthusiastically by the peer helpers. During eighth grade, the students received two "booster" sessions - a reminder of what they learned in seventh grade. HIV-positive young people visited each eighth-grade classroom helping the students realize that HIV infection does happen to teenagers. The eighth-graders also saw a theater presentation, Secrets, sponsored by the Kaiser Permanente Medical Center, which tells the story of a high school student who becomes infected with HIV.

Curriculum

NOTE: The HOT Project ended in 1995. For a list of more recent, effective school-based sexuality/HIV education programs, please see:

Staff

For more information e-mail: Maria Ekstrand Project Director Center for AIDS Prevention Studies [email protected]

Resource

Heterosexual Men - 2018

What Are Heterosexual Men’s HIV Prevention Needs?

Prepared by Joshua Middleton and Reverend William Francis Community Engagement (CE) Core | March 2018

Heterosexual men are affected by HIV

HIV is a concern for heterosexual men, as almost 14% of new male HIV cases in 2016 occurred among heterosexuals, through sex with a woman (9.5%) and injecting drug use (3.9%). Most of those cases were among Black (63%) and Latino (22%) men, and men living in the Southeast (62%) and Northeast (19%) of the US.[1] These statistics, however, may not give us an accurate picture of HIV among heterosexual men. Because sexuality is complex, some heterosexually-identified men may have sex with men, but still identify as straight.[2] The CDC tracks HIV infections through means of infection, not by a person’s identity. Therefore, a heterosexual man who tells his healthcare provider he ever had a sexual encounter with a man is categorized under “men who have sex with men,” and if he says he has ever injected a drug, is categorized under “people who inject drugs (PWID).” Because of this, heterosexual men are seldom mentioned or addressed in the world of HIV prevention, care and research—where men are classified based on federal guidance and misconceptions, and not on men’s own identity.[3] This may be helpful for tracking the HIV epidemic, but it hampers service organizations who want to serve straight men who are at risk for or living with HIV, because funding for programs is linked to mode of transmission.

Fighting stigma

Misunderstanding, discrimination and HIV stigma. Heterosexual men may be reluctant to access testing and education programs at HIV-related organizations because they are concerned they might be labeled as gay or in the closet. Heterosexual men living with HIV can feel excluded from HIV clinics that brand their sites as safe and inclusive spaces for gay and bisexual men, which may be less about homophobia, and more about wanting a safe space for connection with and support from their community.[4] HIV criminalization. Straight men often are blamed for the HIV epidemic among heterosexual women, and may carry guilt, shame and fear of criminal charges. Between 2008 and 2016 in the US, there were 279 cases of HIV criminalization. This occurs when a person is prosecuted for not disclosing their HIV status to a partner. The majority of prosecutions are of heterosexual men.[5] Religion. Religion is an important part of many heterosexual men’s lives, yet sometimes the church may be the place where they are exposed to the beliefs that HIV is a punishment from God, and homosexuality and sex outside of marriage are sins.[6] These religious views may deter open dialogue around HIV, such as HIV testing and prevention, or disclosing HIV status.

Holistic approach

Addressing issues that impact heterosexual men as a whole person—body, mind and spirit—can be more effective than addressing HIV transmission mode. Health inequalities and structural barriers, not necessarily sexual risk taking behaviors, make men more likely to contract HIV and less likely to seek and have access to HIV programs.[3] Family, relationships and intimacy. It is important for heterosexual men to explore their identity as a father, a romantic partner and a member of a family unit.[7] Men view intimacy in many different ways, including being able to communicate with their partner, being transparent and comfortable expressing their feelings, spending quality time with their partners, and having healthy and satisfying sexual lives.[8] Men and boys may need support developing communication skills with their partners. Social injustice and resilience. The largest proportion of heterosexual HIV cases occur among Black men in the Southeast. This is also true for other race/ethnic groups except American Indian/Alaska Native where the largest number is in the West. The second largest number of cases among Black, Latino, and White men occur in the Northeast US. Latino men, the second largest race/ethnic group with HIV also are most affected in the South and Northeast US. Black and Latino men also face disproportionate rates of unemployment, racism, incarceration and lack of education, which can be more pressing issues to contend with than HIV and healthcare. Despite these challenges, many Black men have supportive communities, are highly resilient and persevere. HIV prevention and care services can support Black men by partnering with educational and vocational services to bolster men’s efforts to survive and thrive amid their adversities.[8] Incarceration and post-incarceration services. Programs for heterosexual men should address the impact of incarceration on men, their partners, family and community. Sex with men, sexual assault and injection drug use are risks while incarcerated. People living with HIV (PLWH) may face treatment interruption both in prison and jail, and upon release—which can increase their viral loads and infectivity. Programs can provide education and risk reduction for men affected by incarceration,[9] as well as support finding employment, healthcare and housing upon release.[3]

Quality healthcare

Talking about health. Many men don’t feel comfortable talking about their sexual health and behaviors with their doctors, and doctors typically don’t ask these questions. Cultural male stereotypes and seeing the bulk of health services and promotions focused on women, hamper men’s willingness to seek out health care services, including HIV testing.[10] Healthcare providers need to take a proactive role engaging men, and provide a non-judgmental, safe environment where men can feel free and safe to talk about their sexual health. HIV testing. Providers and clinics need greater awareness that heterosexual men can be at risk for HIV, and should offer all men HIV testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Half of heterosexual men living with HIV were diagnosed 5 years or more after they were infected, later than any other population. Providers should talk to men of every age about HIV and HIV risk reduction, and let them know that HIV testing is a part of routine healthcare.[11] HIV treatment and PrEP. PLWH who are on antiretroviral treatment and have undetectable viral loads do not transmit the virus to their partners.[5] PrEP, a medication for people who do not have HIV, can be used by men and women to protect themselves from HIV safely. These medical breakthroughs can help heterosexual men avoid HIV transmission, safely have children, reduce stress and worry, and increase trust and sexual pleasure in relationships.

Resources and programs

There has been resistance in the HIV community to track, fund, research and provide HIV services for heterosexual men, perhaps due to the focus on the mode of transmission and reluctance to acknowledge men’s own heterosexual identity.[3] For example, for the past five years there have been more new HIV cases from heterosexual transmission than from injecting drug use transmission among men,[1] yet programs and services for PWID far outnumber those for straight men. Programs for heterosexual men should collaborate with mainstream organizations, as straight men are less likely to use HIV-specific services. Programs should reach out to places where straight men go, such as the grocery store, gym, barbershops, sporting events, clubs, churches, colleges, vocational services. Heterosexual men prefer to hear messages from other straight men in community locations.[12] Programs, providers and researchers can do a better job of supporting Black men’s strengths and stop highlighting weaknesses. Increasing HIV testing, education, care and treatment, including PrEP for heterosexual men, can help address HIV. Increasing quality education, job and housing opportunities, as well as providing safe spaces for Black men that foster social support can also address HIV.[7]

Making a difference

It is time to recognize and fully address HIV among heterosexual men. Organizations, health departments and clinics should consider the needs of heterosexual men when planning their budgets, and include men in program planning, service delivery, research and policymaking. Straight men can help fight stigma and invisibility by speaking up, disclosing their status, working in HIV organizations and taking their place at the table to advocate for funding and programs. "Until we all come together, HIV is not going to end." -Rev. Francis

Says who?

1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2016. November 2017; vol. 28. 2. Carrillo H, Hoffman A. From MSM to heteroflexibilities: Non-exclusive straight male identities and their implications for HIV prevention and health promotion. Global Public Health. 2016;11:923-36. 3. Bowleg L, Raj A. Shared communities, structural contexts, and HIV risk: prioritizing the HIV risk and prevention needs of Black heterosexual men. American Journal of Public Health. 2012;102:S173-S177. 4. Kou N, Djiometio JN, Agha A, et al. Examining the health and health service utilization of heterosexual men with HIV: a community-informed scoping review. AIDS Care. 2017;29:552-558. 5. Halkitis PM, Pomeranz JL. It’s time to repeal HIV criminalization laws. Huffington Post. August 1, 2017. 6. Wilson PA,  Wittlin NM, Muñoz-Laboy M, et al. Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men. Global Public Health. 2011;6: S227–S242. 7. Abrahams C, Jones D, Viera A, et al. The forgotten population in HIV prevention: Heterosexual Black/African American men: Key findings and strategies. Harm Reduction Coalition position paper. December 2009. 8. Teti M, Martin AE, Ranade R, et al. “I’m a keep rising. I’m a keep going forward, regardless”: Exploring Black men’s resilience amid sociostructural challenges and stressors. Qualitative Health Research. 2012; 22:524–533. 9. Valera P, Chang Y, Lian Z. HIV risk inside US prisons: A systematic review of risk reduction interventions conducted in US prisons. AIDS Care, 2017;29:943-952. 10. Marcell AV, Morgan AR, Sanders R. The socioecology of sexual and reproductive health care use among young urban minority males. Journal of Adolescent Health. 2017;60:402-410. 11. CDC. HIV testing. CDC National HIV Surveillance System, 2015. 12. Murray A, Toledo L, Brown EE, et al. “We as Black men have to encourage each other:» Facilitators and barriers associated with HIV testing among Black/African American men in rural Florida. Journal of Health Care for the Poor and Underserved. 2017;28:487-498.
Special thanks to the following reviewers of this Fact Sheet: Tony Antoniou, Lisa Bowleg, Derek Canas, Hector Carrillo, Todd Genre, Barbara Green Ajufo, Davina Jones, Steve Kogan, Steven Lamm, Daryl Mangosing, Arik Marcell, Ashley Murray, Bob Siedle-Khan, Michelle Teti, Pamela Valera, Bill Woods Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Fact Sheets are also available in Spanish. ©2018, University of CA. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. This publication is a product of a Prevention Research Center and was supported by Cooperative Agreement Number 5U48DP004998 from the Centers for Disease Control and Prevention.
Resource

Heterosexual men

Heterosexual men are affected by HIV

HIV is a concern for heterosexual men, as almost 14% of new male HIV cases in 2016 occurred among heterosexuals, through sex with a woman (9.5%) and injecting drug use (3.9%). Most of those cases were among Black (63%) and Latino (22%) men, and men living in the Southeast (62%) and Northeast (19%) of the US.[1]

These statistics, however, may not give us an accurate picture of HIV among heterosexual men. Because sexuality is complex, some heterosexually-identified men may have sex with men, but still identify as straight.[2] The CDC tracks HIV infections through means of infection, not by a person’s identity. Therefore, a heterosexual man who tells his healthcare provider he ever had a sexual encounter with a man is categorized under “men who have sex with men,” and if he says he has ever injected a drug, is categorized under “people who inject drugs (PWID).”

Because of this, heterosexual men are seldom mentioned or addressed in the world of HIV prevention, care and research—where men are classified based on federal guidance and misconceptions, and not on men’s own identity.[3] This may be helpful for tracking the HIV epidemic, but it hampers service organizations who want to serve straight men who are at risk for or living with HIV, because funding for programs is linked to mode of transmission.